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    <title>意见征集</title>
</head>
<body>

<div class="g_main">

    <!--=========标题头部开始==========-->
    <div class="g_title">
        <span class="return" onclick="javascript:history.go(-1)"></span>
        <span class="word">意见征集</span>
    </div>
    <!--=========标题头部结束==========-->

    <div class="notice">
    </div>

    <div class="g_query wsts">
        <form class="yjzj_form">
        <p class="title_top title">
            <span>请您认真、真实的填写以下信息，带*号的为必填项<br/>
                    我委收到您的投诉信息后，将尽快予以回复。
            </span>
        </p>
        <p class="title"><span>描述您的意见或建议</span></p>
        <ul>
            <li>
                <span class="word_left">问题所属部门</span>
                <span class="word_right">
                    <select>
                        <option value="房地产处">房地产处</option>
                        <option value="投资计划处">投资计划处</option>
                        <option value="勘察设计处">勘察设计处</option>
                        <option value="公用事业处">公用事业处</option>
                    </select>
                </span>
            </li>
            <li>
                <span class="word_left">问题所属类型</span>
                <span class="word_right">
                    <select>
                        <option value="建筑施工企业安全生产许可">建筑施工企业安全生产许可</option>
                        <option value="燃气经营许可">燃气经营许可</option>
                        <option value="超限高层建筑工程抗震设防许可">超限高层建筑工程抗震设防许可</option>
                    </select>
                </span>
            </li>
            <li>
                <span class="word_left">建议主题</span>
                <span class="word_right">
                    <i class="show_t">建议主题</i>
                    <input type="text" name="tszt" placeholder="点击填写" datatype="*"/>
                </span>
            </li>
            <li>
                <span class="word_left">建议内容</span>
                <span class="word_right">
                    <i class="show_t">建议内容</i>
                    <input type="text" name="tsnr" placeholder="点击填写" datatype="*"/>
                </span>
            </li>
            <li>
                <span class="word_left">上传附件</span>
                <span class="word_right">
                    <label class="upload_label">
                        <input type="file" name="file" onchange="upload()" id="file" />
                    </label>
                    <span id="show_text"></span>
                </span>
            </li>
            <li>
                <span class="word_left">是否同意在网上公开意见建议</span>
                <span class="word_right">
                    <input type="checkbox" id="checkbox_c1" class="chk_3">
                    <label for="checkbox_c1"></label>
                </span>
            </li>
        </ul>
        <p class="title"><span>描述您的个人信息</span></p>
        <ul>
            <li>
                <span class="word_left">您的真实姓名</span>
                <span class="word_right">
                    <i class="show_t">您的真实姓名</i>
                    <input type="text" name="name" placeholder="点击填写" datatype="s2-8"/>
                </span>
            </li>
            <li>
                <span class="word_left">您的联系电话</span>
                <span class="word_right">
                    <i class="show_t">您的联系电话</i>
                    <input type="text" name="lxdh" placeholder="点击填写" datatype="m"/>
                </span>
            </li>
            <li>
                <span class="word_left">您的电子邮箱</span>
                <span class="word_right">
                    <i class="show_t">您的电子邮箱</i>
                    <input type="text" name="email" placeholder="点击填写" datatype="e"/>
                </span>
            </li>
            <li>
                <span class="word_left">您的联系地址</span>
                <span class="word_right">
                    <i class="show_t">您的联系地址</i>
                    <input type="text" name="lxdz" placeholder="点击填写" datatype="*"/>
                </span>
            </li>
        </ul>
        <div class="query_button">
            <button type="button"><span>取消</span></button>
            <button type="button" id="yjzj"><span>提交</span></button>
        </div>
        </form>
    </div>

</div>

</body>
</html>